Tag Archives: Saturated Fat

For over a decade now, a debate has been raging within the nutrition science community. One side views saturated fat as generally unhealthy; they recommend replacing these fats, at least to some degree, with omega-6 polyunsaturated fats. The other side views saturated fat as health-supportive, or at least health-neutral; likewise, they regard omega-6 as somewhat unhealthy and typically recommend decreasing its consumption. So, who has it right? The truth seems to be grey and somewhere in between.

The Modern Diet

Americans have largely followed the US government’s dietary advice for the past 40 years. For example, following official dietary advice in the 80s to reduce fat in our diets, we decreased our fat consumption from 45 to 34% of calories, on average, while increasing our carbohydrate consumption from 39 to 51% of calories [i].

We made these changes because doing so – or so we were told – would decrease cardiovascular disease (CVD), which was and still remains the number one cause of death in the western world.

However, there are also different types of fats (see Figure 1) and both international and US government guidelines have made recommendations about the types of fats we should consume. Current recommendations suggest reducing saturated fat to a maximum of 10% of total calories while increasing omega-6 to somewhere between five and 10% of total calories [ii], [iii].

Figure 1. The basic types of fat.

As a population, we’re pretty much within these recommended zones. We get 11% of our calories from saturated fat and 8% from polyunsaturated fat (primarily the omega-6 variety)[iv], [v].

CVD mortality has declined since its peak in the 1950s, but CVD prevalence remains very high. For example, the total number of inpatient cardiovascular operations and procedures increased 28% between 2000 and 2010 (from 5.9 million to 7.6 million procedures) [vi]. Moreover, prevalence of metabolic syndrome, a precursor to CVD, has reached a staggering 34% of the population [vii].

If the advice to replace saturated fat with omega-6 was designed to reduce CVD, then what went wrong? Was the advice misguided? Let’s look at the evidence.

The Pro-PUFA Studies

Numerous recently published meta-analyses support the conclusion that replacing saturated fat with polyunsaturated fat (though not necessarily omega-6) leads to modest CVD risk reductions. For example:

Study Limitations: PUFA consumption for this study included both omega-6 and omega-3. Therefore, it’s possible the positive results may have been primarily from omega-3; negative effects from omega-6 could have been masked.

Hooper L, et al. (2015) pooled data from 13 long-term RCTs encompassing 53,300 participants. They found “a small but potentially important reduction in cardiovascular risk when saturated fat intake was lowered,” particularly by replacing saturated fat with PUFAs, but not by replacing it with carbohydrates [ix]. However, the study found no clear effect of reducing saturated fat on total mortality.

Study Limitations: Among these RCTs, omega-6 and omega-3 PUFAs were grouped together. Therefore, analyzing the individual impact of either PUFA was not possible.

Study Limitations: (1) Whereas this study did specifically measure omega-6, it didn’t account for the ratio of omega-6 to omega-3 (referred to as “n-6/n-3” hereafter), (2) the meta-analysis only included observational studies, not RCTs, and (3) the meta-analysis measured cardiovascular disease mortality, but not all-cause mortality.

Yanping Li, et al. (2015) conducted a meta-analysis of two observational studies, the first of which followed 85,000 women for 24 years and the second of which followed 43,000 men for 30 years. In total, 7,667 cases of CHD were documented. The authors concluded that replacing 5% of the energy intake from saturated fats with equal energy from PUFAs was associated with a 25% reduced risk of CHD [xi].

Study Limitations: (1) The study was observational (no RCTs were included), (2) the study didn’t account for the n-6/n-3 ratio, and (3) the data was derived from food frequency questionnaires.

Wu JH, et al. (2015) conducted a cohort study of 2,792 older US adults (mean age, 74). To avoid the problems associated with food frequency questionnaires, they analyzed circulating omega-6 (LA only) blood levels, an objective biomarker of LA consumption[xii]. Those within the highest quintile of circulating LA had 13% lower all-cause mortality than those in the lowest quintile. Interestingly, when the authors stratified subjects based on combined LA and omega-3 PUFA concentrations, those in the highest quintile had a 54% lower all-cause mortality risk compared to those in the lowest quintile.

Study Limitations: This study was designed better than most, but didn’t completely demonstrate how changes to the n-6/n-3 ratio affect mortality.

The Anti-PUFA Studies

Christopher Ramsden, MD is a clinical investigator for the National Institutes of Health. During the past decade, Ramsden has been among the most prominent scientists challenging the mainstream narrative that omega-6 should replace saturated fat. Through a series of studies, most of which were published by the British Medical Journal, Ramsden and his colleagues have put forth an important antithesis [xiii], [xiv], [xv]. Some of their conclusions include:

Substituting dietary omega-6 LA in place of SFA increases all-cause mortality risk, as well as risks from coronary heart disease.

Benefits previously attributed to greater intake of total PUFAs may be specifically attributable to omega-3 and not to omega-6 LA.

Some of the problems with the studies used to justify increased omega-6 consumption, according to Ramsden and his colleagues, include:

Failure to distinguish between trials that selectively increased omega-6 and those that substantially increased omega-3

Failure to acknowledge that omega-6 and omega-3 replaced not only SFAs, but large amounts of trans-fats in many trials used in the pro-PUFA meta-analyses

Failure to provide the specific compositions of the diets (particularly with respect to omega-6 and trans-fat) used in the pro-PUFA meta-analyses

Failure to analyze the impact of n-6/n-3 ratios

The Middle Ground

As you can see, the consumption of saturated fat and omega-6 are controversial, partly because we lack rigorous studies specifically designed to test the optimal balance between saturated fat, omega-6, and omega-3. This was precisely the conclusion of a 2015 Cochran review by Al-Khudairy L, et. al. [xvi].

The authors sought RCT data demonstrating the effectiveness of increasing or decreasing omega-6 for the prevention of cardiovascular disease. Additionally, they wanted to assess the impact of total omega-3 consumption and the n-6/n-3 ratio.

Unfortunately, “very few trials were identified with a relatively small number of participants randomized.” They concluded, (1) there is currently insufficient evidence to recommend either increased or decreased omega-6 consumption, and (2) larger, better RCTs on this topic are needed.

Conclusion

In Part 1 of this article series, we’ve seen that many critical questions about optimal saturated- and polyunsaturated fat consumption levels haven’t yet been answered by science. While we wait for better RCTs to be conducted, we can gain deeper insights and a better understanding of this issue by examining the fat consumption patterns of our Paleo ancestors. Be sure to check out Part II of this series, where we’ll do just that.

[xi] Yanping Li, et al. (Oct 2015). Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease. Journal of the American College of Cardiology, 66(14). Retrieved from ().

Anyone who follows the U.S. nutritional guidelines has almost certainly been frustrated at some point or another by the conflicting advice and sometimes hopelessly outdated marketing material – think the Food Pyramid that still graces the walls of many elementary school classrooms.

The frustration has reached the point that cries of government corruption and inappropriate influence of big food industry lobbyists are frequently heard. Case in point, the February 2015 draft of the U.S. Dietary Guidelines,1 published every five years, prompted over 29,000 public comments compared to a couple thousand in 2010. The outcry has been so strong it has led to a Congressional review to start in October.

And just last week journalist Nina Teicholz published a scathing review of the guidelines in the high impact factor journal BMJ.2

Teicholz accused the Dietary Guidelines Advisory Committee (DGAC) of not listing their conflicts of interest, of using reviews from industry influenced professional associations, and of overall “weak scientific standards.” Which is scary considering the importance of the 2015 Dietary Guidelines can’t be understated.

According to Teicholz, “the guidelines have a big influence on diet in the U.S., determining nutrition education, food labeling, government research priorities at the National Institutes of Health (NIH) and public feeding programs.”

So what did the Committee recommend? The overall body of evidence examined by the 2015 DAC identifies that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meats; and low in sugar-sweetened foods and drinks and refined grains.

Certainly not a win for the Paleo community, but also not anything we haven’t heard from these agencies for a long time.

Dr Barbara Millen, the Chair of the Committee, published an immediate response in BMJ claiming that “the procedures used to develop the DGAC scientific report are expansive, transparent, and thoughtful, with multiple opportunities for public input.”1

Millen pointed out that the committee was nominated by their peers and rigorously reviewed. She even fired back at Teicholz saying that she was just one individual with a clear bias herself having written the book The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet.

The biggest point of contention, however, was the methods for selecting the research the recommendations were based on.

In 2010, the US Department of Agriculture established the Nutrition Evidence Library (NEL) to help ensure the quality of nutritional recommendations by establishing standards for identifying and selecting research.3

Teicholz contends that the DGAC “did not use NEL reviews for more than 70 percent of the topics” and instead selected studies ad hoc often relying on reviews by external professional associations.

Millen defended the committee claiming that “you don’t simply answer these questions on the basis of the NEL. On topics where there were existing comprehensive guidelines, we didn’t do them.” Millen also contended that the bulk of their research came from the NIH and other federal agencies.

To her credit, the Guidelines detail four methods of research selection, most of which involved at the least consulting the NEL.

Ultimately, it is the recommendations themselves that will determine the integrity of the report and Teicholz had issues with several of them, all of which are highly relevant to those of us in the Paleo world:

THE CONTESTED RECOMMENDATIONS

Teicholz addressed the recommendation for lower dietary saturated fats first, pointing out that no NEL review of the research on saturated fat from the past five years was conducted. She claimed many conflicting studies were omitted, in particular a large controlled clinical trial known as the Women’s Health Initiative (WHI). No benefits of a lower saturated fat diet were observed in a cohort of 49,000 women over seven years.4

Millen responded that the report states “dietary advice should put the emphasis on optimizing the types of dietary fat and not reducing total fat.”

Next, Teicholz addressed the report’s failure to endorse a low carbohydrate diet claiming critical research was left out including a meta-analysis and a critical review demonstrating a benefit of low carb diets for type 2 diabetes.5, 6 Millen simply replied that there is limited evidence of the long-term health effects.

One of the biggest shifts in the new guidelines was a stronger emphasis on plant-based diets with the recommendation to reduce meat particularly red meat. The draft 2015 Guidelines added for the first time a “Healthy Vegetarian Pattern” to their three recommended diets that also include a “Healthy Mediterranean-Style Pattern” and a “Healthy U.S.-Style Pattern.”

Teicholz contends that there has been no review by the NEL of the health effects of red meat. While an NEL review of a vegetarian diet does exist and states that the evidence is limited for its disease fighting power.7 Yet, Teicholz holds that the report arbitrarily upgraded the rating of the evidence. She also claimed that the Guidelines left out three contradictory NIH studies including one from the WHI that found no significant advantage of a diet high in fruit, vegetables and grains for weight loss, diabetes, heart disease, or cancer.8-11 Even the Guideline’s sole diagram addressing red meat, according to Teicholz, showed that diets high in red meat were equivocal with diets lower in red meat.

Millen did not address the question of red meat in her response, but the report stated that the three recommended dietary patterns reaffirmed the 2010 DGAC recommendations and aligned with the American Institute for Cancer Research (AICR) and the American Health Association (AHA).1

A MORE MUNDANE EXPLANATION

A friend of mine, who by her own admission had a “cushy” well-paid job at a large government nutrition agency, once gave me her impression of government nutrition.

Her job was to follow the current research and take her findings to the higher-ups. She was quickly frustrated by the all-too-common response. They would thank her for bringing it to their attention, then tell her they already knew about it and they weren’t going to do anything. Did she experience, first hand, government corruption or industry influence at play?

My friend had a much more mundane answer. In a government nutrition agency, she said, there’s one unforgivable sin – to make a recommendation contrary to the decades old accepted cannon and end up being wrong. So was something this mundane going on with the DGAC?

The Report starts by asserting it was motivated by the current state of public health in the United States, a lot of which was a result of poor dietary patterns. Half of U.S. adults have a chronic disease and two-thirds are obese. It goes on to say these patterns “adversely affected the health of the U.S. public for decades and raise the urgency for immediate attention and bold action.”1

Yet that “bold action” consists of recommendations that by their own admission are consistent with past DGAC reports.

The few new recommendations they offer – replacing refined grain products with whole grain products and the reduction of refined sugar and sodium in the diet – are neither novel nor in any way controversial within the nutrition community.

Even in the Paleo world, while we would say to bypass the grains altogether, if you’re going to eat them, we’re still generally going to recommend whole grain products over refined empty-calorie snacks.

Perhaps Teicholz’s most poignant criticism of the report was her pointing out “a reluctance by the committee behind the report to consider any evidence that contradicts the last 35 years of nutritional advice.” She goes on to say that with the failure of existing intervention strategies, they should be welcoming new views.

Nowhere is the aging nature of the report potentially more obvious than in its handling of omega-3 fatty acids. As mentioned above, Millen responded to Teicholz by stating that the committee focused more on types of fats than absolute quantity. Which would imply that omega-3 fats were a focus.

Yet omega-3s are mentioned only three times in the 571-page report. Once in the context of wild vs farm raised fish. One paragraph under mental health where they briefly review the vast research showing the benefits of omega-3 for the brain and finally to point out the single study that found an association between nutrients in the diet and type 2 diabetes because it differentiated types of fats.12

The broad ranging health benefits of consuming omega-3 fatty acids, and the ratio of omega-3 to omega-6 fatty acids in the diet are some of the most heavily researched topics currently in nutrition.13 Yet the report made no recommendations about omega-3s. Instead it focused on a decades-old concept of “achieving better saturated fat to polyunsaturated fat ratios.”

IS MUNDANE ANY BETTER?

Teicholz herself concludes by admitting the mundane may be more at play than conflict of interest or industry pressure – “nearly all nutrition scientists accept funding from industry. Of far greater influence is likely to be bias in favor of institutionalized hypothesis.”

Nonetheless, does this really make the end result any better?

The report may very well answer that question itself. It has long been accepted that there is a big difference between refined sugar, refined grain products, and whole grain products despite all being grain-based. The report is careful and thorough in making this distinction and providing very different recommendations for each.

The report also admits to a difficulty in defining meat – “there was variability across the food groupings and this was particularly apparent in the meat group.” Red meats were clumped together with processed meat and chicken, fish was grouped with eggs and sausage.

Yet, after admitting to this issue, the report still stuck with traditional lines. Where it was careful to distinguish different categories of grains and plant foods it still ultimately lumped almost all meat together in its recommendation.

That is with the exception of a small footnote that ultimately contradicted its own recommendations:

As lean meats were not consistently defined or handled similarly between studies, they were not identified as a common characteristic across the reviews. However, as demonstrated in the food patterns modeling of the Healthy US-style and Healthy Mediterranean-style patterns, lean meats can be a part of a healthy dietary pattern.

Whether it was industry influence, conflict of interest, or simply mundane adherence to nutritional cannon, when it came to their final recommendations, they were unable to see the important implications of a distinction they themselves made.

For a nutritional concept to gain traction and remain relevant, nothing matters more than its ability to generate cold, hard cash. In the past, this usually meant governments (and their allied health institutions) would promote certain theories (e.g. the low-fat theory of cardiovascular disease), thereby creating consumer demand, and food manufacturers would respond, formulating products to meet that demand. Whether or not the theories were scientifically sound was relatively unimportant.

In the future, this demand creation model will reverse. Consumers will access scientifically sound nutrition advice, either directly through scientific journals or via independent health advocates, educators, and journalists. This will create demand, which suppliers will meet. Whether or not governments align themselves with scientifically sound nutrition will be somewhat inconsequential.

A monumental new study supports the above prediction while implying the future of Paleo is secure, at least for the next 15 years. Last week, the market research wing of Switzerland’s second largest bank, Credit Suisse, published an impactful analysis called, “Fat: The New Health Paradigm,” in which they project global macronutrient consumption trends for the next 15 years. Specifically, they expect saturated fat and total fat consumption to increase, omega-6 consumption to decrease, and carbohydrate consumption to decrease.[1]

In other words, consumers’ attitudes toward core aspects of the Paleo diet will solidify, thereby creating demand for healthy, high-fat, Paleo-oriented products. According to Stefano Natella, Global Head of Equity Research at Credit Suisse and an author of the study, savvy investors should be lining up behind businesses that understand these forthcoming trends.

“We believe that consumers are at a turning point and this has distinct implications for investors. The report’s conclusion is simple – natural unprocessed fats are healthy and are integral to transforming our society into one that focuses on developing and maintaining healthy individuals.”[2]

Key findings of the study include the following (note: all changes are per capita):

Globally, fat consumption will increase from its current per capita average of 26% of total calories to 31% by 2030.

In the US, fat consumption will increase from its current 40% of total calories to 47%.

Globally, saturated fat will increase from 9.4% of total calories to 12.7%.

Omega-6 consumption will decrease from 6% of total calories to 5.4%.

Carbohydrates will decrease from 60% to 55%.

Red meat consumption will increase 23% by 2030.

Egg consumption will increase 4% per year and by 2030, the average person will consume nearly 300 eggs per year (or 350 per year in the US, compared to the current 235).

During the past century, dietary guidelines restrictive of saturated fat and dietary cholesterol were issued to 220 million US citizens in 1977 and 56 million UK citizens in 1983. According to a systematic review and meta-analysis of research available during those years, neither the US nor the UK guidelines were supported by randomized controlled trials.[3] During the ensuing decades, food companies got rich selling low-fat foods, but only because consumers genuinely believed the low-fat dogma their government’s were propagating.

What if consumers had widespread access to information showing the guidelines were (and continue to be) wrong? Would they change their behavior? Would they alter their demands? Would food companies respond? According to the Credit Suisse report, yes. Consumers are becoming more educated about nutrition and food manufacturers are keenly watching. A lucrative new market is in the works. For the future, the smart money is on Paleo and otherwise healthy food.

REFERENCES

Last week, a threatening letter on its website addressed to , the fruit and nut snack bar company that produces KIND bars, which according to the FDA, violated the Federal Food, Drug, and Cosmetic Act, as well as Title 21 of the Code of Federal Regulations (CFR). The violation? The KIND bars, which contain only fruit, nuts, coconut, and other natural ingredients, contain the word “healthy.”

How can they be “healthy” when, in fact, they contain more than 1 gram of per serving? Yes, according to the CFR, a product cannot be labeled as “healthy” unless it contains less than 1 gram of saturated fat per serving and no more the 15% of total calories from saturated fat.

By this definition, raw, unprocessed almonds, cashews, and macadamia nuts are not “healthy,” and of course, neither is coconut. Never mind science. Forget about tradition. The federal government defines what is and isn’t healthy.

Adding insult to injury, the FDA also asserted in its letter, “Scientific evidence suggests that trans-fat acts in a similar manner to saturated fat with respect to raising LDL cholesterol. Higher total and LDL cholesterol levels are associated with increased risk of developing coronary heart disease.”

The evidence against trans fat is overwhelming, unambiguous, and no longer even debated. A 2006 study published in the prestigious New England Journal of Medicine observed, “On a per-calorie basis, trans fats appear to increase the risk of CHD [coronary heart disease] more than any other macronutrient, conferring a substantially increased risk at low levels of consumption (1 to 3% of total energy intake).”1

Is saturated fat deserving of such a comparison? The current scientific literature, of course, paints a much different picture.

Saturated fat supports health and only increases the benign, large-particle variety of LDL.2 There are two types of LDL, small-particle and large-particle. Small-particle is dense and tends to accumulate along the arterial walls, contributing to aortic plaque and, eventually, cardiovascular disease.3

Kind has agreed to change the labels on their KIND bars, removing the word “healthy.” And who can blame them? When you’re running a company, the last thing you want to do is battle the FDA. But what a sad state of affair in the world of nutrition: healthy foods cannot be labeled as such, while unhealthy foods get the green light.

So, if your Paleo-fueled health improvements inspire you to develop a new product line, which could help others, we encourage you to carefully study the federal regulations regarding health claims used on product labels. The value of the stacks of published, peer-reviewed studies supporting your claims are unparalleled, but until the FDA reforms their own guidelines, focus upon formulating the best product, educate consumers of their benefits, and be sure your packaging conveys the claims both truthfully and lawfully.

The opinions expressed in this article are the author’s own and do not reflect product endorsement by The Paleo Diet, LLC and Dr. Loren Cordain.

Christopher James Clark, B.B.A.

Christopher James Clark, B.B.A. is an award-winning writer, consultant, and chef with specialized knowledge in nutritional science and healing cuisine. He has a Business Administration degree from the University of Michigan and formerly worked as a revenue management analyst for a Fortune 100 company. For the past decade-plus, he has been designing menus, recipes, and food concepts for restaurants and spas, coaching private clients, teaching cooking workshops worldwide, and managing the kitchen for a renowned Greek yoga resort. Clark is the author of the critically acclaimed, award-winning book, .

was likely unrestricted among ancient hunter gatherer populations. For the purpose of efficiency and conservation, entire animals would be consumed.

The USDA and other major government nutrition advocates claim that excess saturated fat intake will lead to exceedingly high cholesterol levels and . Currently, there are no confirmed studies demonstrating the correlation of increased saturated fat intake with a higher risk for cardiovascular mortality. Saturated fat intake might increase LDL cholesterol initially, but it produces protective HDL cholesterol simultaneously.

The Inuit people of North America subsist on a diet that is extremely high in saturated fats, and the majority of the population does not exhibit cardiovascular diseases. The body does indeed , but this is simply for the purpose of future energy expenditure. Saturated fat should not be feared, and is a vital fatty acid for maintaining consistent energy levels while following a Paleo lifestyle.

Bottom line: Saturated fats should be consumed in moderation along with other leaner cuts of meat.

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